Table 2.

Recommendations to Leverage Nurse Practitioner Models of Care in Long-Term Care Settings

Recommendation	Description
1. Maintaining legislative reforms that were initiated during COVID-19 and continuing to remove barriers to NP practices	Continual reform of legislation and maintenance of the changes in legislation that occurred in response to COVID-19 is necessary to ensure that NPs across all states and countries can perform care activities for which they are educated, such as completion of advance directives, determination of capacity, diagnosis, management of medical conditions, prescription of medication, and ordering appropriate tests and appropriate medical supplies for residents. The successful implementation of the full scope of the NP practice may also require a collective effort to revise organizational and payer policies accordingly.32
2. Clearly articulating the roles and responsibilities of NPs and physicians within the different models of care	Clear articulation of the roles and the respective responsibilities of the NP and Physician is required for the different models of care along with acknowledgment of these roles by administrators, staff, and external partners. Future collaborative models in LTC homes will require significant formal and informal consultation between NPs, physicians, and acute care specialists to ensure a truly collaborative model. Planning and provision to address the NPs’ role in LTC homes must respond to the increased complexity of LTC residents and the needs of their families and the multiple roles NPs have, including supporting staff, management, and building and maintaining links between health systems.
3. Conducting additional research to determine the optimal care models with which to achieve the best outcomes for residents, staff, and the health care system	Research aimed at examining and determining optimal NP-physician collaborative models of care is needed. Appropriate models are needed to ensure all residents receive timely high-quality care, positive practice outcomes, and retention of other staff in these settings. Most recently, the Long-Term Care COVID-19 Commission, which was the independent commission launched by the Government of Ontario, Canada, recommended 1 NP for every 120 residents.33 Future research is required to affirm the optimal ratio of NP to residents in LTC homes, but this benchmark can be used as a starting point.
4. Incentivizing work in the LTC sector by providing competitive salaries for NPs	Competitive salaries and benefits for NPs in LTC settings need to be comparable to those NPs in other care settings, including acute care and outpatient care. To ensure this benchmark is met, separate funding for NP positions is required.
5. Developing innovative programs to engage and educate new NPs to work in LTC settings	Innovative programs to train and engage new NPs to work in LTC settings are required. Examples include the expansion of the Post-Acute and Long-Term Care Futures Program provided by the Veterans Administration,34 the Weitzman Institution,35 or the Academic-Practice Partnership for APNs.36 Such programs allow NPs to participate in residency in the LTC setting post graduation and were proposed to support NPs in training in the care of complex older adults in these settings.37